| 沙卫平,严飞,陈国兆.经皮微创椎弓根螺钉内固定治疗胸腰椎压缩性骨折的短期临床疗效研究.骨科,2017,8(3): 194-199. |
| 经皮微创椎弓根螺钉内固定治疗胸腰椎压缩性骨折的短期临床疗效研究 |
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| 投稿时间：2016-09-30 |
| DOI：10.3969/j.issn.1674-8573.2017.03.008 |
| 中文关键词: 脊柱骨折 胸椎 腰椎 骨折固定术，内 外科手术，微创性 |
| 英文关键词: Spinal fractures Thoracic vertebrae Lumbar vertebrae Fracture fixation, internal Surgical procedures, minimally invasive |
| 基金项目:江苏省卫生厅重点学科建设开放课题（WKF2013-02） |
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| 中文摘要: |
| 目的 探讨经皮微创椎弓根螺钉内固定治疗胸腰椎压缩性骨折的短期临床疗效。方法 回顾性研究2012年1月至2015年6月我院收治的胸腰椎骨折且无脊髓神经损伤病人44例，均为单节段椎体骨折，采用经皮微创椎弓根螺钉内固定术的22例纳入经皮微创组，行常规后路切开复位内固定术的22例纳入切开复位组。对比两组病人的手术时间、术中出血量、住院天数、椎体前缘高度比、矢状位后凸Cobb角、疼痛视觉模拟量表（visual analogue scale, VAS）评分等指标。结果 两组病人均未出现术后感染、内固定松动断裂、脊髓神经损伤等并发症。两组病人的术中出血量和住院天数组间比较，差异均有统计学意义（t=21.966，P＜0.0001；t=8.278，P＜0.0001）；两组病人术后1、6、12个月的椎体前缘高度比和Cobb角均较术前明显改善，经皮微创组和切开复位组术后1个月的椎体前缘高度比分别为（91.68±1.94）%、（94.73±0.88）%，差异有统计学意义（t=8.512，P＜0.0001）；但两组术后6、12个月的椎体前缘高度比及术后1、6、12个月的Cobb角比较，差异均无统计学意义（P均＞0.05）；经皮微创组术后1个月的VAS评分为（2.91±0.75）分，明显低于切开复位组的（3.95±1.13）分，差异有统计学意义（t=3.609，P=0.001），但两组病人之间术后6、12个月的VAS评分差异均无统计学意义（P均＞0.05）。结论 经皮微创椎弓根螺钉内固定技术具有损伤小、出血少、术后疼痛轻、康复快的特点，是治疗无脊髓神经损伤的胸腰椎压缩性骨折的有效方法。 |
| 英文摘要: |
| Objective To explore the short-time clinical effects of percutaneous pedicle screw fixation in the treatment of thoracolumbar vertebral compression fractures. Methods A retrospective study was conducted on 44 patients with thoracolumbar fractures from January 2012 to June 2015 in our hospital, and all patients suffered from single segmental vertebral fracture without spinal cord or nerve injury. Twenty-two patients in minimal invasive group were treated by percutaneous pedicle screw fixation, and the rest 22 cases in open reduction group were treated by normally open reduction and internal fixation. The operation time, intraoperative blood loss, length of hospital stay, radiographic vertebral height, kyphosis Cobb angle and the visual analogue scale (VAS) scores were compared between two groups. Results No patients suffered from postoperative infection, internal fixation loosening or breakage, nerve injury or other complications. There were significant differences in blood loss and hospital stay between the two groups (t=21.966, P＜0.0001; t=8.278, P＜0.0001). The radiographic vertebral height and kyphosis Cobb angle were significantly improved after surgery. The radiographic vertebral height was (91.68±1.94)% in minimally invasive group 1 month after surgery, and (94.73±0.88)% in the open reduction group, with the difference being statistically significant (t=8.512, P＜0.0001), but there was no significant differences in the vertebral height and Cobb angle at the 6th and 12th month after operation (P＞0.05 for all). The VAS scores after 1 month in the minimally invasive group was 2.91±0.75, and 3.95±1.13 in the open reduction group, and there was significant differences between two groups (t=3.609, P=0.001), bur no significant difference existed at 6th and 12th month after operation (P＞0.05 for all). Conclusion Minimally invasive percutaneous pedicle screw fixation technology had the characteristics of less injury, less blood loss, less postoperative pain, quicker recovery, and it could be an effective method for the single segment thoracolumbar fractures without neurological injury. |
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